78R7607 KCR-F

By:  Dukes                                                        H.B. No. 2247



A BILL TO BE ENTITLED

AN ACT

relating to certain required coverages for children under health 
benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Article 21.53F, Insurance Code, as added by 
Chapter 683, Acts of the 75th Legislature, Regular Session, 1997, 
is amended by adding Section 9 to read as follows:
	Sec. 9.  LEVEL OF COVERAGE REQUIRED FOR CERTAIN THERAPIES 
FOR CHILDREN WITH DEVELOPMENTAL DELAYS. (a) For purposes of this 
section, rehabilitative and habilitative therapies include:
		(1)  occupational therapy evaluations and services;                    
		(2)  physical therapy evaluations and services;                        
		(3)  speech therapy evaluations and services; and                      
		(4)  dietary or nutritional evaluations.                               
	(b)  A health benefit plan that provides coverage for 
rehabilitative and habilitative therapies may not prohibit or 
restrict payment for covered services provided to a child and 
determined to be necessary to and provided in accordance with an 
individualized family service plan issued by the Interagency 
Council on Early Childhood Intervention under Chapter 73, Human 
Resources Code.
	(c)  Rehabilitative and habilitative therapies described by 
Subsection (b) of this section must be covered in the amount, 
duration, scope, and service setting established in the child's 
individualized family service plan.
	(d)  A health benefit plan issuer may not:                              
		(1)  apply the cost of rehabilitative and habilitative 
therapies described by Subsection (b) of this section to an annual 
or lifetime maximum plan benefit or similar provision under the 
plan; or
		(2)  use the cost of rehabilitative or habilitative 
therapies described by Subsection (b) of this section as the sole 
justification for:
			(A)  increasing plan premiums; or                                     
			(B)  terminating the insured's or enrollee's 
participation in the plan.
	SECTION 2.  This Act takes effect September 1, 2003, and 
applies only to a health benefit plan that is delivered, issued for 
delivery, or renewed on or after January 1, 2004.  A health benefit 
plan that is delivered, issued for delivery, or renewed before 
January 1, 2004, is governed by the law as it existed immediately 
before the effective date of this Act, and the former law is 
continued in effect for that purpose.